Written Pathology

Question 1

Enumerate complications of acute tonsillitis or acute pharyngitis

Answer 1

1. Chronicity: Chronic tonsillitis or pharyngitis.
2. Spread of infection:
   a. Direct: otitis media, pharyngitis, or laryngitis.
   b. Lymphatic: Cervical lymph nodes (lymphadenitis).
   c. Blood: Bacteremia, septicemia, pyemia, or toxemia.
3. Hypersensitivity: Rhematic fever or post-streptococcal glomerulonephritis.

Question 2

Enumerate complications of Diphtheria:

Answer 2

1. Spread of infection:
   a. Direct, blood and lymphatic
2. Asphyxia caused by edema. Pseudo membrane & laryngeal spasm.
3. Cloudy swelling & focal necrosis of parenchymal organs.
4. Acute supra-renal insufficiency: Hemorrhage & necrosis of suprarenal cortex.
5. Temporary paralysis of muscles of palate, pharynx, larynx, eye, face

Question 3

Discuss Rhinoscleroma miscroscope picture

Answer 3

Large macrophage with foamy cytoplasm and pyknotic nucleus
Plasma cells and Russel bodies
Fibrosis

Question 4

Discuss Nasopharyngeal carcinoma microscopic picture

Answer 4

a. Keratinizing squamous cell carcinoma.

b. Non-keratinizing squamous cell carcinoma.

c. Undifferentiated carcinoma with excess lymphocytes

Question 5

Enumerate causes epistaxis

Answer 5

1. Trauma.
2. Tumor: juvenile angiofibroma.
3. Inflammatory: nasal polyp & rhinoscleroma.
4. Foreign bodies.

Question 6

Discuss stages of lobar pneumonia:

Answer 6

1. Congestion: Lasts for 24 hours. The capillaries show hyperemia & lung alveoli are filled with protein rich exudate. The lung is heavy, edematous & red.
2. Red hepatization: From 2nd : 4th day. The alveoli show fibrin with massive accumulation of polymorphs with some lymphocytes & macrophages. Many red cells are extravasated. The lung is red, solid & its consistency resembles fresh liver.
3. Gray hepatization: From 5th : 8th day. Lysis of RBCs occurs. The alveoli show more accumulation of fibrin which shrinks away from alveolar wall. The lung is grey & solid.
4. Resolution: From 8th : 10th day in untreated cases. Neutrophils die releasing proteolytic enzymes causing liquefaction & absorption of the exudate & enzymatic digestion of inflammatory debris. The lung returns to normal.

Question 7

Discuss lobar pneumonia (Def, risk factors, site, fate, complication)

Answer 7

Acute diffuse fibrinous inflammation of lung tissue

Previously healthy middle aged people

Upper lobe of rt lung

resolution

Failure resolution cornification, toxemia may lead to heart failure, spread, lung abscess

Question 8

Discuss bronchopneumonia (Def, risk factors, site, fate, complication)

Answer 8

Patchy areas of acute suppurative
inflammation affects bronchi

Extremes of age and Debilitating diseases

Bilateral basal

Death

pneumonic lung abscess and gangrene, toxemia, septicemia, fibrosis

Question 9

Atypical pneumonia (Def, site, fate, complication)

Answer 9

Inflammation confined to alveolar
septa & interstitium

Patchy and involves whole lobes

Adult respiratory distress syndrome

Upper respiratory tract infection and respiratory distress

Question 10

Enumerate types & causes of lung abscesses

Answer 10

1. Aspiration lung abscess (primary lung abscess): It is due to aspiration of:
   a) Blood clots or infected material during oral surgery.
   b) Vomitus during general anesthesia.
2. Post-pneumonic lung abscess: Multiple in bronchopneumonia or single in lobar pneumonia.
3. Bronchial obstruction with bronchogenic carcinoma: distal atelectasis & aspiration of blood & tumor fragment contribute to
   the development of lung abscess.
4. Pyemic lung abscess: septic emboli from septic thrombophlebitis of systemic veins. Yellow spots surrounded by a zone of congestion.
5. Direct traumatic punctures or spread of infection from adjacent organ.

Question 11

Discuss complications of lung abscess

Answer 11

1. Resolution: in case of small sized abscess & with proper treatment.
2. Rupture:
   a. Into a bronchus: results in hemoptysis & coughing of purulent sputum.
   b. In the pleural cavity: results in empyema & pyopneumothorax.
3. Gangrene: the cavity is irregular with a necrotic lining
4. Embolization of septic material to the brain results in meningitis & brain abscess.
5. Chronicity: Chronic lung abscess is well-defined cavity

Question 12

Discuss bronchial asthma types

Answer 12

A. Atopic (allergic) asthma: the most common type caused by type 1 hypersensitivity reaction triggered by
environmental antigen (pollen, dust, certain foods, …) with positive family history.

B. Non-atopic asthma: hyper-reactivity of airways triggered by respiratory tract infections or chemical irritation with no family
history

C. Aspirin-induces asthma: exact mechanism is unknown.

Question 13

Give the def, etiology, pathogenesis and clinical picture of Emphysema.

Answer 13

Permanent dilation of air spaces of bronchioles

Imbalance between pulmonary proteases & their inhibitors

Smoking & air pollutants recruit neutrophils &
macrophages that release proteases (elastases) causing damage of elastic tissue preventing elastic recoil of the lung during expiration

Barrel chest, Coughing & wheezing, Dyspnea, Finger clubbing due to hypoxia

Question 14

Give the def, etiology, pathogenesis and clinical picture of Bronchiectasis

Answer 14

Abnormal permanent dilatation of medium sized bronchi & bronchioles associated with chronic suppurative inflammation of their walls

Congenital or hereditary, Septic bronchopneumonia, Bronchial obstruction by tumor or foreign body

septic pneumonia, septic bronchopneumonia, lung collapse

Persistent severe cough, culture reveals mixed flora, coughing is associated with morning rising and positional changes

Question 15

Enumerate complications of Emphysema

Answer 15

1. Right sided heart failure & pulmonary hypertension
2. Respiratory failure from defective ventilation, perfusion & diffusion of gases with cyanosis, respiratory acidosis & death
3. Rupture bullae containing air into pleura causing pneumothorax

Question 16

Enumerate types of bronchiectasis dilations

Answer 16

1. Saccular: dilatation of part of circumference of a segment
2. Fusiform: dilatation of the whole circumference of a segment o
3. Cylindrical: dilatation of the whole circumference of the whole length of the bronchus

Question 17

Enumerate complications of Bronchiectasis

Answer 17

1. Spread of infection
2. Hemoptysis with abundant foul smelling, yellowish, red sputum
3. Bilateral lung fibrosis, pulmonary hypertension & right sided heart failure
4. Secondary amyloidosis
5. Squamous metaplasia may lead to squamous cell carcinoma

Question 18

Define atelectasis and collapse and its types

Answer 18

Atelectasis is failure of lung expansion & collapse is acquired deflation of previously inflated lung affecting part or all of one lung.

Resorption collapse: occurs with complete obstruction by mucus plugs or foreign body

Compression collapse: associated with pneumothorax, hemothorax

Question 19

Enumerate predisposing factors of lung cancer

Answer 19

1. Smoking.
2. air pollution
3. Silicosis .
4. Bronchiectasis.

Question 20

Give an account on the types of lung carcinoma

Answer 20

Squamous cell carcinoma: in smoker males, centrally located, infiltrative tumor, keratin pearl formation

Adenocarcinoma: in females, peripherally located, early spread to the pleura, glandular

Large cell carcinoma: undifferentiated type with no glandular or keratin pearl formation

Small cell carcinoma: Worst prognosis, early metastasis, centrally located, cells are small neuroendocrine

Question 21

Enumerate complications of lung carcinoma

Answer 21

Spreads: either directly, lymphatically or blood

Obstruction to organs

Paraneoplastic syndrome causing: hypercalcemia, Cushing syndrome,

Question 22

Discuss causes of pulmonary hypertension

Answer 22

1. Chronic obstructive or interstitial lung diseases.
2. Recurrent pulmonary emboli.
3. Mitral stenosis.
4. Congenital left to right shunt.
5. Idiopathic or primary pulmonary hypertension.

Question 23

Enumerate complications of polycystic disease

Answer 23

Hematuria
Secondary infections
Hypertension
Chronic renal failure

Question 24

Give the clinical manifestation of Nephritic syndrome

Answer 24

Acute onset of gross hematuria hypertension, mild proteinuria, edema

Question 24

Give the clinical manifestation of Nephrotic syndrome

Answer 24

heavy proteinuria, severe edema, hyperlipidemia and lipiduria

Question 24

Discuss the etiology of acute diffuse proliferative GN

Answer 24

During latent period between infection and nephritis, antibodies are formed against streptococcal antigens. The reaction occurs in the serum and the immune complex deposits between glomerular basement membrane and epithelial cells, leading to injury.

Question 25

Discuss the pathogenesis of glomerular injury

Answer 25

Immune mechanism: Antibody mediated injury is the most common type of glomerular injury as glomerular deposits of immunoglobulins and complement are detected in more than 70% of cases Non immune mechanism: loss of glomerular shape and glomerular hyperfiltration

Question 25

Give the cause of membranous nephropathy

Answer 25

may occur association with systemic disease such as infection, carcinoma, drugs and metabolic disorders

Question 26

Define Berger's disease (IGA Nephropathy)

Answer 26

Disease characterized by the presence of prominent IgA deposits in the mesangial region.

Question 27

Enumerate four systemic diseases associated with glomerular lesion

Answer 27

Vasculitis Bacterial endocarditis Amyloidosis SLE

Question 28

Give the causes and types of acute tubular necrosis

Answer 28

Toxic ATN: due to heavy metals, organic solvents, pesticides, antibiotics Ischemic ATN: due to trauma, burns, and infections

Question 29

Give the causes of Acute Pyelonephritis

Answer 29

gram negative bacilli due to: ascending infection (through urethra) , or hematogenous infection (through blood)

Question 30

What are the predisposing factors of Acute Pyelonephritis

Answer 30

General factors: diabetes mellitus and immunosuppression Special factors: urethral catherization, female gender, UTI and stasis of urine

Question 31

Define chronic pyelonephritis and give its causes

Answer 31

Chronic tubulointerstitial inflammation and scarring associated with deformity Causes: obstruction and reflux of UTI with congenial vesicoureteral reflux.

Question 32

Enumerate four causes of urinary tract obstruction (Obstructive uropathy)

Answer 32

Congenital anomalies Tumors Pregnancy Benign prostatic hypertrophy

Question 33

Define Hydronephrosis and give 3 complications

Answer 33

Dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to partial obstruction to the outflow of urine Secondary infection Chronic renal failure Hypertension

Question 34

Define pyonephrosis and give 2 causes

Answer 34

Dilation and distension of the renal pelvis and calyces with pus associated with progressive atrophy of the kidney due to total or almost complete obstruction of the outflow urine. Hydronephrosis Chronic pyelonephritis

Question 35

Enumerate the types of stones

Answer 35

Calcium oxalate Triple phosphate stones Uric acid stones Cystine stones

Question 36

Enumerate factors (pathogenesis) that cause calculi formation in urine

Answer 36

Increase urinary concentration of the stones constituents: increased urinary concentration of calcium, increased uric acid in urine, dehydration Change in pH of urine: infection by urea splitting organism and decrease acidity Lack of substances in urine which inhibit precipitation of crystals

Question 37

Discuss the complications of renal calculi

Answer 37

Migration of stones from pelvicalyceal system to ureters resulting in colics and obstructive uropathy Obstruction produces hydroureter and hydronephrosis Infection: cystits Squamous metaplasia, dysplasia. squamous cell carcinoma and carcinoma insitu

Question 38

Enumerate the tumors of the kidney

Answer 38

Benign tumors: Renal papillary adenoma, angiomyolipoma, oncocytoma, squamous cell papilloma Malignant tumors: renal cell carcinoma, Wilm's tumor, Urothelial carcinoma

Question 39

Give an account on the microscopic features of renal cell carcinoma

Answer 39

Clear cell carcinoma, tumor cells grow in solid sheets, and cord like patterns,

Question 40

Define WILM's Tumor (Nephroblastoma)

Answer 40

most common primary renal tumor of childhood

Question 41

Give the causes of acute renal failure

Answer 41

Pre-renal causes: hemorrhage Renal causes: acute diffuse GN, Acute pyelonephritis, acute tubular necrosis Post renal causes: Sudden complete obstruction of ureter by stone

Question 42

Enumerate the causes of chronic renal failure

Answer 42

Chronic glomerulonephritis Chronic bilateral pyelonephritis Polycystic kidney disease Bilateral hydronephrosis Diabetes mellitus Essential hypertension

Question 43

Discuss the types of cystitis and their causes

Answer 43

Acute cystitis: bacterial suppurative cystitis; caused by E.coli mostly through ascending infections and hemorrhagic cystitis caused by some antitumor drugs Chronic cystitis: Bilharzial cystitis and chronic tuberculous cystitis.

Question 44

Enumerate the predisposing factors of carcinoma in the bladder

Answer 44

Schistosoma haematobium infection Cigarette smoking Industrial carcinogens

Question 45

Discuss the types of carcinoma found in the bladder

Answer 45

Urothelial carcinoma: are either papillary or non papillary. Papillary are superficial and can be removed while non papillary are more invasive and likely yo infiltrate lamina propria of bladder. Squamous cell carcinoma: associated with chronic bladder infection and irritation Adenocarcinoma: fungating mass that invades the bladder wall and ulcerates the mucosa

Question 46

List four renal causes of hematuria

Answer 46

Trauma Tumors of kidney Nephritic syndrome Polycystic kidneys

Question 47

List complications of gonorrhea?

Answer 47

Spread: to seminal vesicles or prostate Sexual transmission to female partner Chronicity Fibrosis-----> obstructive uropathy

Question 48

List the germ cell tumors of the testis?

Answer 48

Seminoma Non seminomatous: Embryonal carcinoma, yolk sac tumor, teratoma, mixed germ cell tumors

Question 49

Define hydrocele and mention 4 causes for it

Answer 49

accumulation of serous fluid in tunica vaginalis cause: idiopathic, inflammation, torsion of testis, tumors of testis

Question 50

Define hematocele and mention 2 causes for it?

Answer 50

Def: collection of blood in tunica vaginalis Causes: traumatic, malignancy tumors of testis, hemorrhagic blood disease

Question 51

Effects and complications of benign prostatic hyperplasia?

Answer 51

Gradual hypertrophy of bladder musculature--> diverticula and dilation of bladder Hydroureter, hydro nephrosis Cystic Bladder calcunli